Journal of Diabetes and Endocrine Practice最新文献

{"title":"Acute Pancreatitis Secondary to Hypertriglyceridemia during Pregnancy","authors":"R. Alenezi, Waleed M. Almutairi, Najla Saleh, Raed Aldahash, Y. Al-Saleh","doi":"10.1055/s-0042-1757702","DOIUrl":"https://doi.org/10.1055/s-0042-1757702","url":null,"abstract":"Abstract Introduction  Hypertriglyceridemia (HTG) (triglycerides > 1,000 mg/dL [11.3 mmol/L]) has been associated with a high risk of developing acute pancreatitis (AP) in pregnant women, but this condition is rare. We present the case of a pregnant Saudi with AP secondary to HTG. Case Report  A 27-year-old Saudi female presented at 30 weeks' gestational age with abdominal pain, nausea, and vomiting of 4 days' duration. AP was diagnosed based on clinical presentation, high lipase, and abdominal ultrasound findings. Her triglyceride level was 58 mmol/L. Fenofibrate and intravenous regular insulin infusion with dextrose were started, which decreased triglycerides by the third day from 58.8 to 29 mmol/L (50% reduction) with a further reduction to 11 mmol/L (81%) by day 7 of her admission. Labor was induced at 37 weeks of gestation, and she delivered a healthy neonate. Conclusion  We report successful treatment of AP in pregnancy with intravenous insulin and fenofibrate. Several case reports have discussed the therapeutic option of AP induced by HTG in pregnancy. Lipid-lowering agents are category C in pregnancy. However, few case reports indicate their safety. Insulin, heparin, and apheresis have also been used during pregnancy without any complications.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"Volume 17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124433706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Care in Conflict Zones: Time for Action Is Long Overdue","authors":"S. Beshyah","doi":"10.1055/s-0042-1748669","DOIUrl":"https://doi.org/10.1055/s-0042-1748669","url":null,"abstract":"Noncommunicable deteriorate or be lost entirely to multiple beyond the Special","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"155 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123496249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenal Histoplasmosis: An Uncommon Cause of Adrenal Crisis in an Immunocompetent Man","authors":"M. Alnuaimi, M. Alblooshi, Amna Alzaabi, Abdulghani S. Elomami, R. Almazrouei","doi":"10.1055/s-0042-1748666","DOIUrl":"https://doi.org/10.1055/s-0042-1748666","url":null,"abstract":"\u0000 Background Histoplasmosis is a rare cause of primary adrenal insufficiency. Adrenal involvement is commonly encountered with disseminated disease in immunocompromised individuals though some have been reported in immunocompetent patients. Primary adrenal histoplasmosis where adrenals are the only organs with demonstrable disease is uncommon.\u0000 Case Presentation A 33-year-old immunocompetent man presented with an adrenal crisis. Further evaluation of the underling etiology of primary adrenal insufficiency revealed bilateral adrenal enlargement that was confirmed to be histoplasmosis on adrenal biopsy.\u0000 Conclusion The case highlights the importance of considering histoplasmosis as an underlying cause of primary adrenal insufficiency in patients from high endemic areas.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123579074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Doctors' Perceptions of Rare Bone Disorders and X-Linked Hypophosphatemia: A Survey from Africa and the Middle East","authors":"Waleed S. Beshyah, H. Alsaffar, S. Beshyah","doi":"10.1055/s-0042-1755441","DOIUrl":"https://doi.org/10.1055/s-0042-1755441","url":null,"abstract":"Abstract Objectives  To assess the perceptions of genetic and metabolic bone disorders with a focus on X-linked hypophosphatemia (XLH) in the Middle East and Africa. Materials and Methods  An online survey of a convenience sample of physicians from relevant disciplines. The questions covered respondents' profiles, awareness of rare bone diseases, and XLH's burden, symptoms, and management. Results  A total of 139 respondents were included in the analysis. Responses came from the Arabian Gulf (41.7%), Middle East (20.1%), North Africa (17.3%), and Sub-Saharan Africa (20.9%). The largest single specialty was endocrinology (41%). When asked, 16 (11.5%) could not know about any metabolic/genetic bone diseases, and 123 respondents (88.5%) stated that they could think/were aware of some metabolic/genetic bone diseases, 111 enumerated various genetic and metabolic disorders. When they were presented with a typical case scenario of XLH, 18.0% of the respondents admitted ignorance of any possibility. However, 82.0% indicated having some idea of the condition. Of the latter group, 109 provided suggestions for possible diagnosis; the top single diagnosis was XLH. A smaller proportion of adult physicians had patients with symptoms attributed to XLH. Around three-quarters of respondents were aware of conventional therapy for XLH with vitamin D and phosphate supplementation. However, 89.8% of respondents welcomed specific biological therapy. Conclusions  Physicians are reasonably aware of XLH but have variable knowledge. They are unsatisfied with its conventional treatment. More in-depth knowledge of recognizing and modern management of bone metabolic and genetic conditions should be enhanced, particularly among adult physicians.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125760502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of Management of Congenital Adrenal Hyperplasia in Developing Countries","authors":"H. Alsaffar","doi":"10.1055/s-0042-1758769","DOIUrl":"https://doi.org/10.1055/s-0042-1758769","url":null,"abstract":"adrenal hyperplasia","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"236 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125188919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Euglycemic Diabetic Ketoacidosis after the Initiation of Treatment in a Patient with New-Onset Type 2 Diabetes Mellitus","authors":"O. Alhaj, B. Afandi","doi":"10.1055/s-0042-1755440","DOIUrl":"https://doi.org/10.1055/s-0042-1755440","url":null,"abstract":"Abstract We report the onset of euglycemic diabetic ketoacidosis (EDKA) in a 20-year-old male patient with new-onset type 2 diabetes mellitus (T2DM) 5 days after the initiation of diet restriction and the combination of SGLT2 (sodium–glucose co-transporter 2) inhibitors, glucagon-like peptide 1 receptor agonists, and metformin. The use of SGLT2 inhibitors in symptomatic patients with new-onset T2DM along with the extreme reduction in carbohydrate intake might trigger the onset of EDKA. Judicious, stepwise use of available diabetes therapies and strict monitoring can reduce the risk of this complication.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"159 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128931282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes and Endocrinology in Practice: Common and Rare Encounters","authors":"S. Beshyah","doi":"10.1055/s-0042-1757638","DOIUrl":"https://doi.org/10.1055/s-0042-1757638","url":null,"abstract":"","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134463482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Choice of Insulin Type and Regimen for Adolescents with Type 1 Diabetes during Ramadan Fasting: A Continuing Debate","authors":"Reem Hassan-Beck, A. Deeb","doi":"10.1055/s-0042-1756469","DOIUrl":"https://doi.org/10.1055/s-0042-1756469","url":null,"abstract":"The intertwined complexity of type 1 diabetes (T1D) and the ampli fi cation of its associated symptoms during Ramadan fasting inevitably imposes a challenge in the appropriate apportionment of insulin. Based on clinical experience, different recommendations on adjusting the type, dose, and timing of insulin in adults have been suggested. 1 However, clear evidence-based guidelines on insulin adjustment for children and adolescents with T1D are lacking","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121144891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience with Congenital Adrenal Hyperplasia in Tripoli Children's Hospital, Libya","authors":"Intisar Abulgassem, Faten BenRajab","doi":"10.1055/s-0042-1757637","DOIUrl":"https://doi.org/10.1055/s-0042-1757637","url":null,"abstract":"Abstract Congenital adrenal hyperplasia (CAH) denotes a group of autosomal recessive disorders. Its clinical spectrum varies from classical CAH (CCAH) to nonclassic CAH. It may be a simple virilizing form or salt-wasting type. The study described the clinical presentation, treatment modalities, and sequelae of CAH, including its effect on patient growth during long-term follow-up. A case series study was conducted on patients with CAH who attended and followed up in the Endocrine Clinic in Tripoli Children's Hospital from January 1, 2000 to December 31, 2018. The presentation and the last visit captured demographic and clinical features at the time of diagnosis, types of CAH (classical vs. nonclassical), investigations, treatment details, and height. All patients underwent biochemical testing and hormonal assay, including adrenocorticotropin hormone (ACTH), 17-hydroxyprogesterone (17-OHP), and plasma renin activity (PRA) levels before and after treatment. Fifty-eight patients were included; 38 (65.5.2%) were female, age at presentation in 94.8% ranged between 1 day and 10 years, with a mean age of 2.3 ± 1.1 years. Ambiguous genitalia was the presenting feature in 55.2 and 84% of total and female patients, respectively. Salt wasting was present in 37.9%. Of 32 female patients with ambiguous genitalia, only 11 (34.4%) out of them and 19% of all patients had a surgical correction. The mean and standard deviation of height at diagnosis was 78.327 + 31.070, and the last visit after treatment was 108.345 + 31.781. The relation between the date of birth and height throughout follow-up for those at last visit with age ranges from 13 to 18 years old, their mean and standard deviation of height was 135.650 + 29.286, and for patients who were less than13 years at last visit, the mean and standard deviation of height was 101.079 + 32.121; p -value = 0.003. The Z -scores were calculated and showed that about eight patients were positively above the average mean of the population. Biochemical disturbances were improved after treatment, including sodium, potassium, and glucose in CCAH type; p -value < 0.001. Hormonal findings included levels of ACTH, 17-OHP, and PRA; all levels were reduced with treatment; p -value < 0.001. In this single-center series, most of our patients with biochemical and hormonal abnormalities were normalized with hormonal replacement and limited surgical correction of females with ambiguous genitalia.","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"66 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124008526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Knowledge of X-linked Hypophosphatemia among Clinicians in the Arabian Gulf and African Countries","authors":"M. Z. Mughal","doi":"10.1055/s-0042-1757704","DOIUrl":"https://doi.org/10.1055/s-0042-1757704","url":null,"abstract":"Rare bone disorders comprise 5% of all rare disorders.1 These diverse and heterogeneous disorders are often progressive and associatedwith impairedmobility, chronic pain, and poor quality of life. Thus, patients often require lifelong multidisciplinary care, including medical therapies, surgeries, and the provision of aids for activities of daily living. X-linked hypophosphatemia (XLH) is one such rare bone condition. In the current issue of JDEP, Beshyah et al2 undertook an online survey of clinicians in the Middle East and African countries to determine their knowledge of rare metabolic bone disorders and, more specifically, about XLH. While more than 80% of respondents were aware of XLH, the survey identified significant gaps in the clinicians’ knowledge of symptoms of the condition and its management during the life course. The findings of this survey are broadly similar to those reported by Deeb et al.3 They undertook an online survey to determine the awareness, knowledge, and management of XLH among members of the Arab Society for Pediatric Endocrinology and Diabetes. XLH (OMIM 307800) is the most common form of inherited rickets and osteomalacia, affecting 1 in 20,000 to 60,000 people worldwide.4,5 It is caused by mutations in the phosphate-regulating endopeptidase homolog on the X chromosome (PHEX) gene that lead to an increase in fibroblast growth factor 23 (FGF23) levels, which causes renal phosphate wasting, reduced intestinal phosphate absorption, and low active vitamin D, ultimately resulting in chronic hypophosphatemia. It is a progressive disorder that leads to lifelong impairment of skeletal, muscular, dental, and auditory systems.6 It is also associated with poor quality of life in adults5 and increased mortality.7 The burden of the disease in patients with XLH progresses with age.8–10 For more than 40 years, the treatment of XLH consisted of the administration of phosphate salts four to six times a day along with active analogs of vitamin D—calcitriol (1,25 (OH)2D) or alfacalcidol (1-hydroxycholecalciferol). This is often referred to as the “conventional therapy of XLH,”which helps heal rickets and osteomalacia and improve lower limb deformities, linear growth, and dental health.11,12 However, the response to treatment is variable, and many patients are left with residual lower limb deformities requiring surgical correction. The conventional therapy is more effective in children when treatment is started early, ideally<2 years of age.13 Phosphate supplements have an unpleasant taste and side effects: nausea, vomiting, abdominal pains, and diarrhea. Thus, poor adherence to treatment is not uncommon, especially among adolescents. Conventional medicine is also associated with an increased risk of hypercalcemia, nephrocalcinosis, nephrolithiasis, impaired renal function, secondary hyperparathyroidism, and tertiary hyperparathyroidism.11,12 In 2018, burosumab, a fully humanmonoclonal antibody that inhibits excess circulating FGF23, a","PeriodicalId":294186,"journal":{"name":"Journal of Diabetes and Endocrine Practice","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116555141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}